Preparing for Your ACL Surgery

One of the most powerful predictors of a successful ACL recovery is your mindset.
Patients who approach surgery with confidence, consistency, and ownership of their outcome tend to achieve the best results.

Surgery repairs your ligament — you restore your knee.
The rehabilitation process, guided by your surgeon and physical therapist, is where progress truly happens. Every exercise, every day of movement, and every bit of effort adds up to your long-term success.

Think of this as a partnership between you, your body, and your care team. The more you invest in your preparation and recovery, the better your function, confidence, and long-term knee health will be.

• Before surgery: Focus on “prehab” exercises, managing swelling, and preparing your home and support system.
• Day of surgery: Most ACL procedures are outpatient, and you’ll return home the same day.
• Immediately after: The top priority is regaining full knee extension and beginning gentle muscle activation.
• Rehabilitation: Over the next several months, you’ll rebuild strength, control, and movement — step by step — until you return to your desired activities.

Logistics

• Arrange a ride home and a support person for the first 24 hours.
• Prepare a recovery area with pillows, chargers, and easy access to essentials.  A good snack goes a long way.
• Plan meals, childcare, and time off work.
• Review all medication and fasting instructions from your surgical team.

Supplies

• Crutches or walker (practice beforehand)
• Ice packs or a cold therapy unit
• Compression sleeve or elastic wrap
• Loose, comfortable clothing and slip-on shoes
• Pillows or foam wedges for elevation

These exercises prepare your muscles and joints for surgery and improve your ability to recover afterward.  Aim to perform 4–6 days per week. If an exercise causes sharp pain, stop and consult your care team.  No exercise should cause any instability or giving way of the knee.  Further instability events before surgery can cause further damage and should be avoided.  Any twisting, pivoting, or impact activities should be avoided.

Warm-Up

• Stationary Bike (5–10 minutes):
  Light resistance pedaling improves circulation, reduces stiffness, and keeps your knee mobile.
  • Adjust seat height so your knee is slightly bent at the bottom of the pedal stroke.
  • If full circles are difficult, start with partial revolutions and progress as motion improves

Foundational Strength & Mobility

1. Quad Sets
   Tighten the thigh muscle (quadriceps) by pressing the back of your knee into the bed.
   Hold for 5–10 seconds, repeat 10–15 times.
   Goal: Maintain active quadriceps control.
2. Straight Leg Raises
   Lie on your back, tighten the thigh, and lift your leg ~12 inches, keeping the knee straight.
   Hold for 2–3 seconds, then lower slowly. 10–15 repetitions, 2–3 sets.
   If you can do this without the knee lagging, you’re ready for post-op progress.
3. Heel Slides
   Gently bend your knee by sliding your heel toward your buttocks, then return to straight.
   10–15 reps, 2–3 sets.
4. Seated Knee Extensions (“Terminal Knee Extensions”)
   Sit or stand with a rolled towel behind your knee. Straighten your leg fully and tighten your quad.
   Hold 3–5 seconds, repeat 15–20 times.
   This movement is key for achieving and maintaining full extension.
5. Body Weight Squats
   Stand with feet shoulder-width apart, sit hips back and down as if sitting in a chair, then stand up.
   Keep knees behind toes and chest upright. 2–3 sets of 10 reps.
   Only perform if you can do so without swelling or pain.
6. Step-Ups (Low Step)
   Step up with your surgical leg, press through the heel, and slowly step down.
   10 reps each leg, 2 sets.
   Focus on control, not speed.
7. Bridges
   Lie on your back, knees bent, feet flat. Lift hips until shoulders–hips–knees form a straight line.
   Hold 5 seconds, lower slowly. 10–15 reps, 2–3 sets.
   Activates hamstrings and glutes, supporting knee stability.

The most important goal immediately after ACL surgery is regaining full knee extension — the ability to completely straighten your leg.
Lack of full extension can lead to long-term stiffness, difficulty walking, and poor quadriceps activation.

Practicing extension exercises before surgery trains your brain and muscles to find that position easily afterward.

Extension Exercises (Do Before and After Surgery)

1. Heel Prop
   Sit or lie with your heel resting on a pillow or rolled towel, allowing the knee to gently straighten.
   Hold for 3–5 minutes, 2–3 times daily.
   You should feel a mild stretch behind the knee, not pain.
2. Prone Hang
   Lie face down on a bed with your knee and leg hanging off the edge. Let gravity gently straighten your knee.
   Hold for 2–3 minutes, once or twice daily.
3. Quad Activation in Extension
   While holding the extended position, tighten your quad muscle and press the back of the knee down.
   Hold 5–10 seconds, repeat 10–15 times.
   Combines muscle activation with joint positioning for faster recovery.

Morning: Stationary bike (5–10 min), quad sets (2×10), heel slides (1×10), straight leg raises (2×10)
Afternoon: Body weight squats (2×10), bridges (2×15), step-ups (2×10), balance practice (3×20 sec)
Evening: Heel prop for 5 minutes, ice and elevate, gentle quad sets in full extension

Consistency is key — small daily efforts before surgery build a foundation for faster, easier recovery afterward.